Pain Myths •Neonates don’t experience pain •Children have no memory of pain •There is a correct amount of pain for
a given injury •Children cannot tell where they hurt •Children can easily become addicted
to narcotics •Narcotics can easily cause respiratory depression Assume that situations/procedures that would be painful in older children and adults are also painful for babies Pain in children •Pain is whatever the child says it is and exists whenever the child says it does •Child’s report of pain is the most reliable diagnostic measurement of pain •Incorporate family •Nurse –Advocate –Educate •Do not undermedicate –Children may not admit or may deny pain –Young children don’t understand relationship between our assessment and management of pain and their relief Two Types of Pain •Acute –Sudden onset –Limited period •Chronic –Unpredictable time limit –Unlikely to resolve quickly –Affects child’s ability to live normal life –Children with chronic pain may: -withdraw -have school absences -experience sleep disturbances -experience personality changes -Prior experiences can increase or decrease sensitivity depending on whether or not adequate relief was obtained. (This esp. applies to older children and adolescents.) -When the child has chronic pain, their regimen is continued in the hospital. Acute pain superimposed on the chronic pain should be treated with additional opioids. Evaluation of pain management regimen •Response to therapy should be evaluated 15-30 minutes after each dose •IV pain med-15 min •IM pain med-30 min •Oral and nonpharmacologic therapies-30-60 min Pain behavior –Vocalizations, –Facial expressions –Body movements and posture –Changes in state Psychological indicators of pain •Provide indirect estimates of pain •Produced by the anxiety associated with pain •Are of limited value as sole indicator of pain •Best for infants and children who cannot communicate verbally Vital signs •-Temporary changes produced by the anxiety associated with pain •-Elevated vital signs will return to normal despite persistence of •pain •-Not accurate measure of pain over time •Pallor or flushing •Diaphoresis •Palmar sweating Pain Assesment •FACES (3 years and older) •FLACC (2 months to 7 years) •Numeric rating scale (NRS) •Visual analog scale (VAS) (7 years and older) •CRIES: (Crying; Requiring inc oxygen; Increased vital signs; Expression and Sleeplessness) •PIPP: Premature Infant Pain Profile •NPASS: Neonatal Pain, Agitation, and Sedation Scale •CHEOPS (Described in ATI) o1 to 5 years o4 = no pain; 13 = worst pain o-Response to touch
Pain Myths
• Neonates don’t experience pain
• Children have no memory of pain
• There is a correct amount of pain for
a given injury
• Children cannot tell where they hurt
• Children can easily become addicted
to narcotics
• Narcotics can easily cause respiratory depression
Assume that situations/procedures that would be painful in older children and adults are also painful for babies
Pain in children
• Pain is whatever the child says it is and exists whenever the child says it does
• Child’s report of pain is the most reliable diagnostic measurement of pain
• Incorporate family
• Nurse
– Advocate
– Educate
• Do not undermedicate
– Children may not admit or may deny pain
– Young children don’t understand relationship between our assessment and management of pain and their relief
Two Types of Pain
• Acute
– Sudden onset
– Limited period
• Chronic
– Unpredictable time limit
– Unlikely to resolve quickly
– Affects child’s ability to live normal life
– Children with chronic pain may:
-withdraw
-have school absences
-experience sleep disturbances
-experience personality changes
- Prior experiences can increase or decrease sensitivity depending
on whether or not adequate relief was obtained. (This esp. applies
to older children and adolescents.)
-When the child has chronic pain, their regimen is continued in the
hospital. Acute pain superimposed on the chronic pain should be
treated with additional opioids.
Evaluation of pain management regimen
• Response to therapy should be evaluated 15-30 minutes after each dose
• IV pain med-15 min
• IM pain med-30 min
• Oral and nonpharmacologic therapies-30-60 min
Pain behavior
– Vocalizations,
– Facial expressions
– Body movements and posture
– Changes in state
Psychological indicators of pain
• Provide indirect estimates of pain
• Produced by the anxiety associated with pain
• Are of limited value as sole indicator of pain
• Best for infants and children who cannot communicate verbally
Vital signs
• -Temporary changes produced by the anxiety associated with pain
• -Elevated vital signs will return to normal despite persistence of
• pain
• -Not accurate measure of pain over time
• Pallor or flushing
• Diaphoresis
• Palmar sweating
Pain Assesment
• FACES (3 years and older)
• FLACC (2 months to 7 years)
• Numeric rating scale (NRS)
• Visual analog scale (VAS) (7 years and older)
• CRIES: (Crying; Requiring inc oxygen; Increased vital signs; Expression and Sleeplessness)
• PIPP: Premature Infant Pain Profile
• NPASS: Neonatal Pain, Agitation, and Sedation Scale
• CHEOPS (Described in ATI)
o 1 to 5 years
o 4 = no pain; 13 = worst pain
o -Response to touch